Effect of Balloon Embedded Bifurcating Stenting with Single Stent Strategy for Side Branch Protection

Background: Intervention for bifurcation lesions is associated with increased risk of adverse events and includes acute side branch (SB) occlusion during main branch (MB) stenting. This acute occlusion of side branch can often be catastrophic for the patient. We here in describe our experience in National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh with a technique which can be incorporated into bifurcation stenting to reduce or almost eliminate the incidence of side branch occlusion or catastrophe. Methods: A prospective, observational, non-blinded study in patients from a single tertiary referral cardiac center National Institute of Cardiovascular Diseases & Hospital (NICVD), Dhaka, Bangladesh. Patients with an indication for percutaneous coronary intervention (PCI) of a denovo bifurcation lesion were screened. The study included 51 patients who underwent coronary angiogram in our institution and had bifurcation lesions suitable for single stent strategy between March 2017 to September 2018. Results: 51 patients with bifurcation lesion were included in the study and underwent a balloon embedded bifurcation stenting with a semi inflated balloon placed across the SB ostium. Angiographic success was achieved in all the patients but procedural success was achieved in 88.2% of the patients. TIMI 3 flow of main branch (MB) was achieved 96.08% and side branch (SB) was achieved 88.2%. Incidence of dissection was 5.9%, acute occlusion of SB was 2.0% and MACE was 3.9%. Mean fluoroscopy time and contrast volume was similar to that of conventional bifurcation stenting. The jailed SB balloon and wire could be successfully removed in all patients. Conclusion: The present study suggests that balloon embedded bifurcation stenting with a semi inflated balloon to protect the SB is feasible, with minimal procedural adverse events and successful in minimizing or almost eliminating the incidence of acute side branch occlusion or dissection as well as MACE. Bangladesh Heart Journal 2021; 36(1): 17-23

Patient-specific computational simulation of coronary artery bifurcation stenting

Patient-specific and lesion-specific computational simulation of bifurcation stenting is an attractive approach to achieve individualized pre-procedural planning that could improve outcomes. The objectives of this work were to describe and validate a novel platform for fully computational patient-specific coronary bifurcation stenting. Our computational stent simulation platform was trained using n = 4 patient-specific bench bifurcation models (n = 17 simulations), and n = 5 clinical bifurcation cases (training group, n = 23 simulations). The platform was blindly tested in n = 5 clinical bifurcation cases (testing group, n = 29 simulations). A variety of stent platforms and stent techniques with 1- or 2-stents was used. Post-stenting imaging with micro-computed tomography (μCT) for bench group and optical coherence tomography (OCT) for clinical groups were used as reference for the training and testing of computational coronary bifurcation stenting. There was a very high agreement for mean lumen diameter (MLD) between stent simulations and post-stenting μCT in bench cases yielding an overall bias of 0.03 (− 0.28 to 0.34) mm. Similarly, there was a high agreement for MLD between stent simulation and OCT in clinical training group [bias 0.08 (− 0.24 to 0.41) mm], and clinical testing group [bias 0.08 (− 0.29 to 0.46) mm]. Quantitatively and qualitatively stent size and shape in computational stenting was in high agreement with clinical cases, yielding an overall bias of < 0.15 mm. Patient-specific computational stenting of coronary bifurcations is a feasible and accurate approach. Future clinical studies are warranted to investigate the ability of computational stenting simulations to guide decision-making in the cardiac catheterization laboratory and improve clinical outcomes.

Five-year outcomes of implantation of Absorb biodegradable stents using the bifurcation stenting technique: a case report

The presented case report describes a five-year outcomes of bifurcation stenting of the left anterior descending artery and large diagonal branch with Absorb bioabsorbable vascular stent (BVS) according to selective coronary angiography and optical coherence tomography. The example demonstrates not only the successful implantation of biodegradable stents into the bifurcation area, but also the complete restoration of the arterial wall with the formation of neocarina. Optical coherence tomography made it possible to study in detail all stages of vascular wall alterations from the inside. This case report prompts a fresh look at the biodegradable BVS Absorb stents and does not rule out the potential of returning these stents to clinical practice in the future. Currently, the production and use of Absorb BVSs has been suspended, but they have filled a certain niche in the endovascular treatment of patients with coronary artery disease.